Yonsei Med J.  2015 Nov;56(6):1582-1589. 10.3349/ymj.2015.56.6.1582.

Elevation of Serum Aminotransferase Levels and Future Risk of Death from External Causes: A Prospective Cohort Study in Korea

• Sohn J
• Kang DR
• Kim HC
• Cho J
• Choi YJ
• Kim C
• Suh I

• KMID: 2345886
• DOI: http://doi.org/10.3349/ymj.2015.56.6.1582

Abstract

PURPOSE
The association between liver enzymes and death from external causes has not been examined. We investigated the association between serum aminotransferase levels and external-cause mortality in a large prospective cohort study.
MATERIALS AND METHODS
A total of 142322 subjects of 35-59 years of age who completed baseline examinations in 1990 and 1992 were enrolled. Mortalities were identified using death certificates. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were categorized into quintiles. Sub-distribution hazards ratios and 95% confidence intervals (CIs) were estimated using a competing risks regression model in which deaths from other causes were treated as competing risks.
RESULTS
Of 8808 deaths, 1111 (12.6%) were due to external causes. Injury accounted for 256 deaths, and suicide accounted for 255. After adjusting for covariates, elevated ALT and AST were significantly associated with an increased risk of all external-cause mortalities, as well as suicide and injury. Sub-distribution hazards ratios (95% CIs) of the highest versus the lowest quintiles of serum ALT and AST were, respectively, 1.57 (1.26-1.95) and 1.45 (1.20-1.76) for all external causes, 2.73 (1.68-4.46) and 1.75 (1.15-2.66) for suicide, and 1.79 (1.10-2.90) and 1.85 (1.21-2.82) for injury. The risk of external-cause mortality was also significantly higher in the fourth quintile of ALT (21.6-27.5 IU/L) than in its first quintile.
CONCLUSION
Elevated aminotransferase levels, even within the normal range, were significantly associated with increased risk of all external-cause mortalities, including suicide, and injury.

Keyword

Liver enzymes; external-cause mortality; cardiovascular disease; hepatic disease

MeSH Terms

Adult
Alanine Transaminase/*blood/metabolism
Aspartate Aminotransferases/*blood/metabolism
Female
Humans
Male
Middle Aged
*Mortality
*Population Surveillance
Proportional Hazards Models
Prospective Studies
Republic of Korea/epidemiology
Risk
Alanine Transaminase
Aspartate Aminotransferases

Figure

• 

  Fig. 1 Cumulative incidences of deaths from external causes based on (A) serum alanine aminotransferase and (B) aspartate aminotransferase stratified into quintiles.

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